Physician Wages in States with Expanded APRN Scope of Practice

In recent years, states have looked to reforms in advanced practice nursing scope of practice (SOP) barriers as a potential means to increase access to primary care while reducing costs. Currently, 16 states and the District of Columbia permit advanced practice registered nurses to practice independently of physicians, allowing them to perform functions such as diagnosing and prescribing under their own authority within the primary care setting. Given the resistance of many physician associations to these reforms, we asked whether the economic interests of primary care physicians might be affected by reforms. Using the Bureau of Labor Statistics data on earnings, we compared primary care physicians' earnings in states that have instituted SOP reforms to those that maintain these practice barriers. We also compared surgeons' earnings as a control group. Lastly, we compared the rate of growth in the earnings of primary care physicians and surgeons over the last ten years. This preliminary analysis revealed no evidence of differences in earnings across the two groups of states

CEO Perspectives on Factors Determining Medical Staff Configurations in CHCs

OBJECTIVE While financial incentives to adopt team-based care are mounting, little is known about how leaders of primary care organizations make decisions regarding medical staff configurations. This study explores perceptions of CEOs of community health centers (CHCs) that have a variety of staff configurations. DATA/SETTING We used the 2012 Uniform Data System to identify a maximum variety sample of CHCs with unusually high proportions of advanced practice providers, nurses, medical assistants, case managers, or community health workers. DESIGN/METHODS We conducted semistructured interviews with CEOs at 19 selected CHCs about factors that influenced their medical staff configuration decisions. RESULTS We found that CEOs considered two major dimensions in their decisions: choice and balance of providers (physicians versus nurse practitioners [NPs] and physician assistants [PAs]) and configuration of clinical support staff. Across these decision domains, CEOs consider contextual issues (e.g., local labor supply, wage gaps between professions, scope of practice regulations, local payment policies, and institutional history), as well as their own perceptions of individual attributes, the quality of specific professions, and the likelihood of retention. Strong preferences emerged for a balance among physicians and NPs/PAs and the inclusion of nurses with stackable degrees. CONCLUSIONS This study provides a preliminary framework for understanding how CEOs at CHCs weigh staffing options in a variety of contexts. This framework can serve to inform research on the comparative effectiveness of different staffing configurations and improve national and state workforce projection models

Workforce planning and development in times of delivery system transformation

Background As implementation of the US Affordable Care Act (ACA) advances, many domestic health systems are considering major changes in how the healthcare workforce is organized. The purpose of this study is to explore the dynamic processes and interactions by which workforce planning and development (WFPD) is evolving in this new environment. Methods Informed by the theory of loosely coupled systems (LCS), we use a case study design to examine how workforce changes are being managed in Kaiser Permanente and Montefiore Health System. We conducted site visits with in-depth interviews with 8 to 10 stakeholders in each organization. Results Both systems demonstrate a concern for the impact of change on their workforce and have made commitments to avoid outsourcing and layoffs. Central workforce planning mechanisms have been replaced with strategies to integrate various stakeholders and units in alignment with strategic growth plans. Features of this new approach include early and continuous engagement of labor in innovation; the development of intermediary sense-making structures to garner resources, facilitate plans, and build consensus; and a whole system perspective, rather than a focus on single professions. We also identify seven principles underlying the WFPD processes in these two cases that can aid in development of a new and more adaptive workforce strategy in healthcare. Conclusions Since passage of the ACA, healthcare systems are becoming larger and more complex. Insights from these case studies suggest that while organizational history and structure determined different areas of emphasis, our results indicate that large-scale system transformations in healthcare can be managed in ways that enhance the skills and capacities of the workforce. Our findings merit attention, not just by healthcare administrators and union leaders, but by policymakers and scholars interested in making WFPD policies at a state and national level more responsive

Workforce Planning & Development in Times of Delivery System Transformation: The Stories of Kaiser Permanente and Montefiore Health System

As the implementation of the Affordable Care Act (ACA) advances, many health systems are taking bold measures to reorganize how they deliver care, and finding that in order to do so; they need to make major changes in how their healthcare workforces are organized.Understanding what workforce changes are occurring and how they are being managed is important not just for healthcare leaders, but for policymakers as well. Traditional methods of projecting provider shortages and justifying the allocation of public funding to expand various professional pipelines are giving way to the notion that there are many models of care delivery and that they have vastly different staffing configurations. Choices about staffing can have enormous implications for productivity, making assumptions about the demand for certain health professions a moving target.The authors focused on two very different health systems, Kaiser Permanente and Montefiore Health System, to better understand how diverse organizations are adapting to and planning for workforce changes in the post-ACA environment. They set out to examine not only how changes in healthcare delivery will alter the national demand for health workers, but also how individual organizations make choices about ways to reconfigure their workforce, and, ultimately, what kinds of local, state and federal policies will be most supportive of workforce transformations that advance both workers’ wellbeing and the value of their services

Clinical Support Personnel in the U.S. Hospitals: Job Trends from 2010-2014

The use of various forms of Clinical Support Personnel (CSP), who perform healthcare tasks under the supervision of registered nurses and other licensed healthcare providers has been used as a primary strategy for managing professional shortages (Huston, 1996; Zimmerman, 2000), while at the same time reducing costs (Orne, Garland, O’Hara, Perfetto, & Stielau, 1998; Keenan, 2003). The purpose of this analysis is to better understand how hospitals are using CSP, and to explore changes that may have occurred since the 2010 passage of the Affordable Care Act. We use the term CSP to refer to a portion of the allied health workforce who are hospital-based clinical support personne

Using a New Evidence-Based Health Workforce Innovation Research Framework to Compare Innovations in Community Health Center and Other Ambulatory Care Settings

In the United States, changing demographics, rising costs, and the impact of new regulations and payment models arising from the Affordable Care Act have placed unprecedented pressures on healthcare providers to increase access to care, improve quality and to control costs. To meet these challenges, some providers are forming accountable care organizations (ACOs) while others are pursuing medical homes or other novel payment and care delivery models designed to help meet these challenges. Within established organizations such as federally funded community health centers (CHCs), healthcare leaders are exercising significant latitude in developing innovative solutions for meeting their patients’ needs more effectively and efficiently. One important way they are accomplishing this is through novel workforce arrangements that place health workers in new or expanded roles, new team arrangements or new locations. Key Goals To develop a framework that can be used to describe the drivers/motivators, mechanisms and outcomes of health workforce innovation so they can be used to guide future research in this area. This framework can help to identify patterns in emergent workforce arrangements, and can help researchers and planners to formulate hypotheses and study the implications of health workforce innovations in different contexts. To use the framework to compare and contrast health workforce innovations in community health centers and other ambulatory care settings. This information can help HRSA and other policymakers to understand the implications of health workforce changes for planning, education, and labor market projections, both in CHCs and in ambulatory care more generally

Use of Telehealth in NHSC Grantee Sites

Telehealth has long been viewed as an important pathway for increasing access to care for underserved populations, while providing high quality care at low cost. The spread of telehealth in the United States, however, has been hampered by a range of reimbursement, equipment costs, and licensure barriers. In this study we examined the extent to which telehealth is being used in settings that are among the locations most in need: the National Health Service Corps (NHSC) approved grantee sites. Key Questions To what extent and how are NHSC using telehealth and telemedicine services? What are the barriers to adoption and expansion from the perspective of NHSC scholars and loan repayment participants? What contextual factors are associated with high and low use

Nurse-Related Clinical Non-licensed Personnel in U.S. Hospitals and their Relationship with Nurse Staffing Levels

The use of the minimally trained, low wage clinical non-licensed personnel (CNLP), who perform clinical tasks under the supervision of registered nurses (RNs) or other licensed clinical providers, has been a primary strategy for hospitals both to manage professional shortages and reduce costs (Huston 1996; Zimmerman 2000; Orne et al. 1998; Keenan 2003). This study examined the nurse-related clinical non-licensed personnel (CNLP) staffing in U.S. hospitals between 2010 and 2014, in terms of their job categories, staffing trends, and relationship with registered nurse (RN) and licensed practical nurse (LPN) staffing. Key Questions: How were CNLPs used in hospitals in 2014 in comparison to registered nurse (RN) and licensed practice nurse (LPN) staffing levels? How did the variations in staffing for these CNLP groups correlate with RN and LPN staffing, as well as other factors such as patient mix? How have these relationships changed over time